Classification of Mental and Behavioural Disorders
The ICD-10Classificationof Mental andBehaviouralDisordersDiagnosticcriteriafor researchWorld Health OrganizationGeneva
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The ICD-10Classificationof Mental andBehaviouralDisordersDiagnosticcriteriafor researchWorld Health OrganizationGeneva1993
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ContentsPrefaceAcknowledgementsNotes for usersICD-10 Chapter V(F) and associated diagnostic instrumentsList of categoriesDiagnostic criteria for researchAnnex 1. Provisional criteria for selected disordersAnnex 2. Culture-specific disordersList of individual expertsList of field trial coordinating centres, field trial centres reporting to them, and directorsIndex
INTRODUCTION In the early 1960s, the Mental Health Programme of the World Health Organization (WHO) became activelyengaged in a programme aiming to improve the diagnosis and classification of mental disorders. At that time, WHOconvened a series of meetings to review knowledge, actively involving representatives of different disciplines, variousschools of thought in psychiatry, and all parts of the world in the programme. It stimulated and conducted research oncriteria for classification and for reliability of diagnosis, and produced and promulgated procedures for joint rating ofvideotaped interviews and other useful research methods. Numerous proposals to improve the classification of mentaldisorders resulted from the extensive consultation process, and these were used in drafting the Eighth Revision of theInternational Classification of Diseases (ICD-8). A glossary defining each category of mental disorder in ICD-8 was alsodeveloped. The programme activities also resulted in the establishment of a network of individuals and centres whocontinued to work on issues related to the improvement of psychiatric classification (1,2). The 1970s saw further growth of interest in improving psychiatric classification worldwide. Expansion ofinternational contacts, the undertaking of several international collaborative studies, and the availability of new treatmentsall contributed to this trend. Several national psychiatric bodies encouraged the development of specific criteria forclassification in order to improve diagnostic reliability. In particular, the American Psychiatric Association developedand promulgated its Third Revision of the Diagnostic and Statistical Manual, which incorporated operational criteria intoits classification system.
In 1978, WHO entered into along-term collaborative project with the Alcohol, Drug Abuse and Mental HealthAdministration (ADAMHA) in the USA, aiming to facilitate further improvements in the classification and diagnosis ofmental disorders, and alcohol- and drug-related problems (3). A series of workshops brought together scientists from anumber of different psychiatric traditions and cultures, reviewed knowledge in specified areas, and developedrecommendations for future research. A major international conference on classification and diagnosis was held inCopenhagen, Denmark, in 1982 to review the recommendations that emerged from these workshops and to outline aresearch agenda and guidelines for future work (4). Several major research efforts were undertaken to implement the recommendations of the Copenhagenconference. One of them, involving centres in 17 countries, had as its aim the development of the CompositeInternational Diagnostic Interview, an instrument suitable for conducting epidemiological studies of mental disorders ingeneral population groups in different countries (5). Another major project focused on developing an assessmentinstrument suitable for use by clinicians (Schedules for Clinical Assessment in Neuropsychiatry) (6). Still another studywas initiated to develop an instrument for the assessment of personality disorders in different countries (the InternationalPersonality Disorder Examination) (7). In addition, several lexicons have been, or are being, prepared to provide clear definitions of terms (8). Amutually beneficial relationship evolved between these projects and the work on definitions of mental and behavioraldisorders in the Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD-10) (9).Converting diagnostic criteria into
diagnostic algorithms incorporated in the assessment instruments was useful in uncovering inconsistencies, ambiguitiesand overlap and allowing their removal. The work on refining the ICD-10 also helped to shape the assessmentinstruments. The final result was a clear set of criteria for ICD-10 and assessment instruments which can produce datanecessary for the classification of disorders according to the criteria included in Chapter V (F) of ICD-10. The Copenhagen conference also recommended that the viewpoints of the different psychiatric traditions bepresented in publications describing the origins of the classification in the ICD-10. This resulted in several majorpublications, including a volume that contains a series of presentations highlighting the origins of classification incontemporary psychiatry (10). The Clinical descriptions and diagnostic guidelines was the first of a series of publications developed fromChapter V (F) of ICD-10 (11). This publication was the culmination of the efforts of numerous people who havecontributed to it over many years. The work has gone through several major drafts, each prepared after extensiveconsultation with panels of experts, national and international psychiatric societies, and individual consultants. The draftin use in 1987 was the basis of field trials conducted in some 40 countries, which constituted the largest ever researcheffort of its type designed to improve psychiatric diagnosis (12,13). The results of the trials were used in finalizing theclinical guidelines. The text presented here has also been extensively tested (14), involving researchers and clinicians in 32 countries.A list of these is given at the end of the book together with a list of people who helped in drafting texts or
commented on them. Further texts will follow: they include a version for use by general health care workers, amultiaxial presentation of the classification, a series of fascicles dealing in more detail with special problems (e.g. afascicle on the assessment and classification of mental retardation) and "crosswalks" - allowing cross-reference betweencorresponding terms in ICD-10, ICD-9 and ICD-8. Use of this publication is described in the Notes for Users. The Appendix provides suggestions for diagnosticcriteria which could be useful in research on several conditions which do not appear as such in the ICD-10 (except asindex terms) and crosswalks allowing the translation of ICD-10 into ICD-9 and ICD-8 terms. The Acknowledgementssection is of particular significance since it bears witness to the vast number of individual experts and institutions, all overthe world, who actively participated in the production of the classification and the various texts that accompany it. Allthe major traditions and schools of psychiatry are represented, which gives this work its uniquely international character.The classification and the guidelines were produced and tested in many languages; the arduous process of ensuringequivalence of translations has resulted in improvements in the clarity, simplicity and logical structure of the texts inEnglish and in other languages. The ICD-10 proposals are thus a product of collaboration, in the true sense of the word, between very manyindividuals and agencies in numerous countries. They were produced in the hope that they will serve as a strong supportto the work of the many who are concerned with caring for the mentally ill and their families, worldwide.
No classification is ever perfect: further improvements and simplifications should become possible with increasesin our knowledge and as experience with the classification accumulates. The task of collecting and digesting commentsand reasults of tests of the classification will remain largely on the shoulders of the centres that collaborated with WHO inthe development of the classification. Their addresses are listed below because it is hoped that they will continue to beinvolved in the improvement of the WHO classifications and associated materials in the future and to assist theOrganization in this work as generously as they have so far. Numerous publications have arisen from Field Trial Centers describing results of their studies in connection withICD-10. A full list of these publications and reprints of the articles can be obtained from WHO, Division of MentalHealth, Geneva. A classification is a way of seeing the world at a point in time. There is no doubt that scientific progress andexperience with the use of these guidelines will require their revision and updating. I hope that such revisions will be theproduct of the same cordial and productive worldwide scientific collaboration as that which has produced the current text.Norman Sartorius,Director, Division of Mental HealthWorld Health Organization
References1. Kramer M et al. The ICD-9 classification of mental disorders: a review of its development and contents. Acta psychiatrica scandinavica, 1979, 59: 241-262.2. Sartorius N. Classification: an international perspective. Psychiatric annals, 1976, 6: 22-35.3. Jablensky A et al. Diagnosis and classification of mental disorders and alcohol- and drug-related problems: a research agenda for the 1980s. Psychological medicine, 1983, 13: 907-921.4. Mental disorders, alcohol- and drug-related problems: international perspectives on their diagnosis and classification. Amsterdam, Excerpta Medica, 1985 (International Congress Series, No. 669).5. Robins L et al. The composite international diagnostic interview. Archives of general psychiatry, 1989, 45: 1069-1077.6. Wing JK et al. SCAN: Schedules for clinical assessment in neuropsychiatry. Archives of general psychiatry, 1990, 47: 589-593.7. Loranger AW et al. The WHO/ADAMHA International Pilot Study of Personality Disorders. Archives of general psychiatry (in press).8. Loranger AW et al. The WHO/ADAMHA International Pilot Study of Personality Disorders: background and purpose. Journal of personality disorders, 1991, 5: 296-306.9. Lexicon of psychiatric and mental health terms. Vol. I. Geneva, World Health Organization, 1989.10. International Statistical Classification of Diseases and Related Health Problems. Tenth Revision. Vol. 1: Tabular list. Vol. 2: Instruction manual. Vol. 3: Index. Geneva, World Health Organization, 1992.11. Sartorius N et al., eds. Sources and traditions in classification in psychiatry. Toronto, Hegrefe and Huber, 1990.
12. The ICD-10 Classification of Mental and Behavioural Disorders. Clinical descriptions and diagnostic guidelines. Geneva, World Health Organization, 1992.13. Sartorius N et al., eds. Psychiatric classification in an international perspective. British journal of psychiatry, 1988, 152 (Suppl.).14. Sartorius N et al. Progress towards achieving a common language in psychiatry: results from the field trials of the clinical guidelines accompanying the WHO Classification of Mental and Behavioural Disorders in ICD-10. Archives of general psychiatry, 1993, 50: 115-124.15. Sartorius N et al. Progress towards achieving a common language in psychiatry. II: Diagnostic criteria for research for ICD-10 Mental and Behavioural Disorders. Results from the international field trials. American journal of psychiatry (in press).
AcknowledgementsMany individuals and organizations have contributed to the production of the classification of mental and behaviouraldisorders in ICD-10 and to the development of the texts that accompany it. The Acknowledgements section of the ICD-10 Clinical descriptions and diagnostic guidelines1 contains a list of researchers and clinicians in some 40 countries whoparticipated in the trials of that document. A similar list is provided on pages xx-xx of this work. It is clearly impossibleto list all those who have helped in the production of the texts and in their testing, but every effort has been made toinclude at least all those whose contributions were central to the creation of the documents that make up the ICD-10"family" of classifications and guidelines.Dr A. Jablensky, then Senior Medical Officer in the Division of Mental Health of WHO in Geneva, coordinated the firstpart of the programme, and thus made a major contribution to the development of the proposals for the text of the criteria.After the proposals for the classification had been assembled and circulated for comment to WHO expert panels andmany other individuals, an amended version of the classification was produced for field tests. Tests were conductedaccording to a protocol produced by WHO staff with the help of Dr J.E. Cooper and other consultants mentioned below,and involved a large number of centres (listed on pages xx-xx) whose work was coordinated by Field Trial CoordinatingCentres. The Coordinating Centres, listed below and on pages xx-xx, also undertook the task of producing equivalentversions of Diagnostic criteria for research in the languages used in their countries.-------------1 The ICD-10 Classification of Mental and Behavioural Disorders. Clinical descriptions and diagnostic guidelines. Geneval, World Health Organization, 1992.
Dr N. Sartorius had overall responsiblity for the work on classification of mental and behavioural disorders inICD-10 and for the production of accompanying documents. Throughout the work on the ICD-10 documents, Dr J. E. Cooper acted as a chief consultant to the project andprovided invaluable guidance and help to the WHO coordinating team. Among the team members were Dr J. vanDrimmelen, who has worked with WHO from the beginning of the process of developing ICD-10 proposals, Dr B. Üstünwho has made particularly valuable contributions during the field trials of the criteria and the analysis of the data theyproduced. Mr A. LHours, technical officer, Strengthening of Epidemiological and Statistical Services, providedgenerous support, ensuring compliance between the ICD-10 development in general and the production of thisclassification. Mrs J. Wilson conscientiously and efficiently handled the innumerable administrative tasks linked to thefield tests and other activities related to the project. Mrs Ruthbeth Finerman, associated professor in anthropology,provided the information upon which Appendix 2: Culture-specific disorders, is based. A number of other consultants, including Dr A. Bertelsen, Dr H. Dilling, Dr J. Lopez-Ibor, Dr C. Pull, Dr D.Regier, Dr M. Rutter and Dr N. Wig, were also closely involved in this work, functioning not only as heads of FTCCs forthe field trials but also providing advice and guidance about issues in their area of expertise and relevant to the psychiatrictraditions of the groups of countries about which they were particularly knowledgeable.
Among the agencies whose help was of vital importance were the Alcohol, Drug Abuse and Mental HealthAdministration in the USA, which provided generous support to the activities preparatory to the drafting of ICD-10, andwhich ensured effective and productive consultation between groups working on ICD-10 and those working on the fourthrevision of the American Psychiatric Associations Diagnostic Statistical Manual (DSM-IV) classification. Close directcollaboration with the chairmen and the work groups of the APA task force in DSMIV chaired by Dr A. Frances allowedan extensive exchange of views and helped in ensuring compatibility between the texts. Invaluable help was alsoprovided by the WHO Advisory Committee on ICD-10, chaired by Dr E. Strömgren; the World Psychiatric Associationand its special committee on classification, the World Federation for Mental Health, the World Association forPsychosocial Rehabilitation, the World Association of Social Psychiatry, the World Federation of Neurology, theInternational Union of Psychological Societies, and the WHO Collaborating Centres for Research and Training in MentalHealth, located in some 40 countries, were particularly useful in the collection of commments and suggestions from theirparts of the world. Governments of WHO Member States, including in particular Belgium, Germany, the Netherlands, Spain and theUSA, also provided direct support to the process of developing the classification of mental and behavioural disorders,both through their designated contributions to WHO and through contributions and financial support to the centres thatparticipated in this work.Field Trial Coordinating Centres and Directors:
Dr A. Bertelsen, Institute of Psychiatric Demography, Psychiatric Hospital, University of Aarhus, 8240 Risskov,DenmarkDr D. Caetano, Department of Psychiatry, Universidade Estadual de CampinasCaixa Postal 1170, 13100 Campinas, S.P., BrazilDr S. Channabasavanna, National Institute of Mental Health and Neuro Sciences, P.O. Box 2979, Bangalore 560029,IndiaDr H.Dilling, Klinik für Psychiatrie der Medizinischen Hochschule, Ratzeburger Allee 160, 2400 Lübeck, GermanyDr M. Gelder, Department of Psychiatry, Oxford University Hospital,Warneford Hospital, Old Road, Headington, Oxford, United KingdomDr D. Kemali, Istituto di Psichiatria, Prima Facoltà Medica, Università di Napoli, Largo Madonna della Grazie, 80138Napoli, ItalyDr J.J. Lopez Ibor Jr., Clinica Lopez Ibor, Av. Nueva Zelanda 44Puerto de Hierro, Madrid 35, SpainDr G. Mellsop, The Wellington Clinical School, Wellington Hospital, Wellington 2, New ZealandDr Y. Nakane, Department of Neuropsychiatry, Nagasaki University, School of Medicine, 7-1 Sakamoto-Machi,Nagasaki 852, Japan
Dr A. Okasha, Department of Psychiatry, Ain Shams University, 3 Shawarby Street, Kasr-El-Nil, Cairo, EgyptDr Ch. Pull, Service de Neuropsychiatrie, Centre Hospitalier de Luxembourg, 4, rue Barblé, Luxembourg, LuxembourgDr D. Regier, Director, Division of Clinical Research, Room 10-105, National Institute of Mental Health, 5600 FishersLane, Rockville, Md. 20857, USADr S. Tzirkin, All Union Research Centre of Mental Health, Institute of Psychiatry, Academy of Medical Sciences,Zagorodnoye Shosse d.2, Moscow 113152USSRDr Xu Tao-Yuan, Department of Psychiatry, Shanghai Psychiatric Hospital, 600 Wan Ping Nan Lu, Shanghai, PeoplesRepublic of ChinaFormer Directors of FTCCs:Dr J. Cooper, Department of Psychiatry, Queens Medical Centre, Clifton Boulevard, Nottingham NG7 2UH, UnitedKingdomDr R. Takahashi, Department of Psychiatry, Tokyo Medical and Dental University, 5-45 Yushima, 1-Chome, Bunkyo-ku, Tokyo, JapanDr N. Wig, Regional Adviser for Mental Health, World Health Organization Regional
Office for the Eastern Mediterranean, P.O. Box 1517, Alexandria 21511, EgyptDr Young Derson, Hunan Medical College, Changsha, Hunan, China
NOTES FOR USERS1. The Diagnostic Criteria for Research accompanying the ICD-10 (DCR-10) are designed for use in research; their content is derived from the Glossary to the chapter on Mental and Behavioural Disorders in the ICD-10 (Chapter V(F)). They provide specific criteria for diagnoses contained in the "Clinical Descriptions and Diagnostic Guidelines" (CDDG) that have been produced for general clinical and educational use by psychiatrists and other mental health professionals (WHO 1992).2. Although completely compatible with the Glossary in ICD-10 and the CDDG, the DCR-10 have a different style and lay-out. Researchers using the DCR-10 should first make themselves familiar with the CDDG, since the DCR-10 are not designed to be used alone. The DCR-10 do not contain the descriptions of the clinical concepts upon which the research criteria are based, nor any comments on commonly associated features which, although not essential for diagnosis, may well be relevant for both clinicians and researchers. These are to be found, for each disorder in turn, in the CDDG. The introductory chapters of the CDDG also contain information and comments that are relevant for both clinical and research uses of the ICD-10. It is presumed that anyone using the DCR-10 will have a copy of the CDDG.3. In addition to the obvious differences in lay-out and detail between the DCR-10 and the CDDG, there are some other differences between them that need to be appreciated before the DCR-10 can be used satisfactorily.a) The DCR-10, like other published diagnostic criteria for research, are purposefully restrictive in that their use allows the selection
of groups of subjects whose symptoms and other characteristics resemble each other in clearly stated ways. This increases the likelihood of obtaining homogenous groups of patients but limits the generalizations that can be made. Researchers wishing to study the overlap of disorders or the best way to define boundaries between them may therefore need to supplement the criteria so as to allow the inclusion of atypical cases depending upon the purposes of the study.b) With a few exceptions, it is not appropriate to provide detailed criteria for the "other" (.8) categories in the overall classification of Chapter V F, and by definition it is never appropriate for "unspecified" (.9). Appendix 1 (pxx) contains suggestions for criteria for some of these exceptions; their placement in an Appendix implies that although their present status is somewhat controversial or tentative, further research on them is to be encouraged.c) Similarly, there is no requirement for extensive rules on mutual exclusions and co-morbidity in a set of diagnostic criteria for research, since different research projects have varied requirements for these, depending upon their aims. Some of the more frequently used and obvious exclusion clauses have been included in the DCR-10 as a reminder and for the convenience of users, and if required more can be found in the CDDG.4. The general ICD rule of not using interference with social role performance as a diagnostic criterion has been followed in the DCR-10 as far as possible. There are a few unavoidable exceptions, the mostobvious being Dementia, Simple Schizophrenia and Dissocial Personality Disorder. Once the decision had been made to include these somewhat controversial disorders in the classification, it was considered best to do so without modifying the concepts. Experience and further research
should show whether these decisions were justified.For many of the disorders of childhood and adolescence, some form of interference with social behaviour and relationships is included amongst the diagnostic criteria. At first sight this appears to go against the general ICD rule that interference with the performance of social roles should not be used as defining characteristics of disorders or diseases. But a close examination of the disturbances that are being classified in F8 and F9 shows that social criteria are needed because of the more complicated and interactive nature of the subject matter. Children often show general misery and frustration, but rarely produce specific complaints and symptoms equivalent to those that characterise the more individually conceptualised disorders of adults. Many of the disorders in F8 and F9 are joint disturbances which can only be described by indicating how roles within the family, school or peer group are affected.The problem is apparent rather than real, and is caused by the use of the term "disorder" for all the sections of Chapter V(F). The term is used to cover many varieties of disturbance, and different types of disturbance need different types of information to describe them.5. For the same reasons as given in 3c), definitions of remission, relapse, and duration of episodes have been provided in the DCR-10 in only a limited number of instances. Further suggestions will be found in the Lexicon of terms to Chapter V (F) of ICD-10.6. The criteria are labelled with letters or numbers to indicate their place in a hierarchy of generality and importance. General criteria that must be fulfilled by all members of a group of disorders (such as the general criteria for all varieties of dementia, or for the main types of schizophrenia) are labelled with a capital G, plus a number. Obligatory
criteria for individual disorders are labelled by capitals only (A,B,C, etc.). Ordinary numbers (1,2,3, etc.) and lower case letters (a,b, etc.) are used to identify further groups and sub-groups of characteristics, of which only some are required for the diagnosis. To avoid the use of "and/or", when it is specified that either of two criteria is required, then it is always assumed that the presence of both criteria also satisfies the requirement.7. When the DCR-10 are used in research on patients who also suffer from neurological disorders, researchers may wish to use the Neurological Adaptation of the ICD-10 (ICD-10NA (in press)) and the accompanying glossary (in preparation).8. The two Appendices to this volume deal with disorders of uncertain or provisional status. Appendix 1 contains some affective disorders that have been the subject of recent research, and some personality disorders that although regarded as clinically useful in some countries, are of uncertain status from an international viewpoint. It is hoped that their inclusion here will encourage research concerning their usefulness.Appendix 2 contains provisional descriptions of a number of disorders that are often referred to as "culture specific". There are grounds for supposing that they might be better regarded as cultural variants of disorders already present in ICD-10 Chapter V(F), but reliable and detailed clinical information is still too scanty to allow definite conclusions to be drawn about them. The considerable practical difficulties involved in doing field studies of persons with these disorders are recognised, but the provision of these descriptions may act as a stimulus to research by those with a knowledge of the languages and cultures concerned.
ICD-10 CHAPTER V(F) AND ASSOCIATED DIAGNOSTIC INSTRUMENTS The Schedule for Clinical Assessment in Neuropsychiatry (SCAN), the Composite International DiagnosticInterview (CIDI), and the International Personality Disorder Examination (IPDE) have been developed in theframework of the WHO/ADAMHA Joint Project on Diagnosis and Classification of Mental Disorders, Alcohol- andDrug- related Problems. More information about these instruments, can be obtained through the Division of MentalHealth, WHO Headquarters in Geneva. Training in the use of these instruments can at present be obtained in the following languages: Chinese,Danish, Dutch, English, French, German, Greek, Hindi, Kannada, Portuguese, Spanish, Tamil and Turkish.
List of categoriesF00-F09Organic, including symptomatic, mental disordersF00 Dementia in Alzheimers disease F00.0 Dementia in Alzheimers disease with early onset F00.1 Dementia in Alzheimers disease with late onset F00.2 Dementia in Alzheimers disease, atypical or mixed type F00.8 Dementia in Alzheimers disease, unspecifiedF01 Vascular dementia F01.0 Vascular dementia of acute onset F01.1 Multi-infarct dementia F01.2 Subcortical vascular dementia F01.3 Mixed cortical and subcortical vascular dementia F01.8 Other vascular dementia F01.9 Vascular dementia, unspecifiedF02 Dementia in other diseases classified elsewhere F02.0 Dementia in Picks disease F02.1 Dementia in Creutzfeldt-Jakob disease F02.2 Dementia in Huntingtons disease F02.3 Dementia in Parkinsons disease F02.4 Dementia in human immunodeficiency virus [HIV] disease F02.8 Dementia in other specified diseases classified elsewhereF03 Unspecified dementiaA fifth character may be used to specify dementia in F00-F03, as follows: .x0 Without additional symptoms .x1 With other symptoms, predominantly delusional .x2 With other symptoms, predominantly hallucinatory .x3 With other symptoms, predominantly depressive .x4 With other mixed symptoms A sixth character may be used to indicate the severity of the dementia: .xx0 Mild .xx1 Moderate .xx2 Severe
F04 Organic amnesic syndrome, not induced by alcohol and other psychoactive substancesF05 Delirium, not induced by alcohol and other psychoactive substances F05.0 Delirium, not superimposed on dementia, so described F05.1 Delirium, superimposed on dementia F05.8 Other delirium F05.9 Delirium, unspecifiedF06 Other mental disorders due to brain damage and dysfunction and to physical disease F06.0 Organic hallucinosis F06.1 Organic catatonic disorder F06.2 Organic delusional [schizophrenia-like] disorder F06.3 Organic mood [affective] disorder .30 Organic manic disorder .31 Organic bipolar disorder .32 Organic depressive disorder .33 Organic mixed affective disorder F06.4 Organic anxiety disorder F06.5 Organic dissociative disorder F06.6 Organic emotionally labile [asthenic] disorder F06.7 Mild cognitive disorder .70 Not associated with a physical disorder .71 Associated with a physical disorderF06.8 Other specified mental disorders due to brain damage and dysfunction and to physical diseaseF06.9 Unspecified mental disorder due to brain damage and dysfunction and to physical diseaseF07 Personality and behavioural disorders due to brain disease, damage and dysfunction F07.0 Organic personality disorder F07.1 Postencephalitic syndrome F07.2 Postconcussional syndromeF07.8 Other organic personality and behavioural disorders due to brain disease, damage and dysfunctionF07.9 Unspecified mental disorder due to brain disease, damage and dysfunctionF09 Unspecified organic or symptomatic mental disorder
F10-F19Mental and behavioural disorders due to psychoactive substance useF10.- Mental and behavioural disorders due to use of alcoholF11.- Mental and behavioural disorders due to use of opioidsF12.- Mental and behavioural disorders due to use of cannabinoidsF13.- Mental and behavioural disorders due to use of sedatives or hypnoticsF14.- Mental and behavioural disorders due to use of cocaineF15.- Mental and behavioural disorders due to use of other stimulants, including caffeineF16.- Mental and behavioural disorders due to use of hallucinogensF17.- Mental and behavioural disorders due to use of tobaccoF18.- Mental and behavioural disorders due to use to volatile solventsF19.- Mental and behavioural disorders due to multiple drug use and use of other psychoactive substancesFour-, five- and six-character categories are used to specify the clinical conditions as follows, and diagnostic criteriaparticular to each psychoactive substance are provided where appropriate for acute intoxication and withdrawal state: F1x.0 Acute intoxication .00 Uncomplicated .01 With trauma or other bodily injury .02 With other medical complications .03 With delirium .04 With perceptual distortions .05 With coma .06 With convulsions .07 Pathological intoxication F1x.1 Harmful use
F1x.2 Dependence syndrome .20 Currently abstinent .200 Early remission .201 Partial remission .202 Full remission .21 Currently abstinent, but in a protected environment.22 Currently on a clinically supervised or replacement regime [controlled dependence].23 Currently abstinent, but receiving treatment with aversive or blocking drugs .24 Currently using the substance [active dependence] .240 Without physical features .241 With physical features .25 Continuous use .26 Episodic use [dipsomania] F1x.3 Withdrawal state .30 Uncomplicated .31 With convulsions F1x.4 Withdrawal state with delirium .40 Without convulsions .41 With convulsions F1x.5 Psychotic disorder .50 Schizophrenia-like .51 Predominantly delusional .52 Predominantly hallucinatory .53 Predominantly polymorphic .54 Predominantly depressive psychotic symptoms .55 Predominantly manic psychotic symptoms .56 Mixed F1x.6 Amnesic syndrome F1x.7 Residual disorders and late-onset psychotic disorder .70 Flashbacks .71 Personality or behaviour disorder .72 Residual affective disorder .73 Dementia .74 Other persisting cognitive disorder .75 Late-onset psychotic disorder
F1x.8 Other mental and behavioural disordersF1x.9 Unspecified mental and behavioural disorder
F20-F29Schizophrenia, schizotypal and delusional disordersF20 Schizophrenia F20.0 Paranoid schizophrenia F20.1 Hebephrenic schizophrenia F20.2 Catatonic schizophrenia F20.3 Undifferentiated schizophrenia F20.4 Post-schizophrenic depression F20.5 Residual schizophrenia F20.6 Simple schizophrenia F20.8 Other schizophrenia F20.9 Schizophrenia, unspecifiedA fifth character may be used to classify course: .x0 Continuous .x1 Episodic with progressive deficit .x2 Episodic with stable deficit .x3 Episodic remittent .x4 Incomplete remission .x5 Complete remission .x8 Other .x9 Course uncertain, period of observation too shortF21 Schizotypal disorderF22 Persistent delusional disorders F22.0 Delusional disorder F22.8 Other persistent delusional disorders F22.9 Persistent delusional disorder, unspecifiedF23 Acute and transient psychotic disordersF23.0 Acute polymorphic psychotic disorder without symptoms of schizophreniaF23.1 Acute polymorphic psychotic disorder with symptoms of schizophrenia F23.2 Acute schizophrenia-like psychotic disorder F23.3 Other acute predominantly delusional psychotic disorder F23.8 Other acute and transient psychotic disorders F23.9 Acute and transient psychotic disorder, unspecified
A fifth character may be used to identify the present or absence of associated acute stress: .x0 Without associated acute stress .x1 With associated acute stressF24 Induced delusional disorderF25 Schizoaffective disorders F25.0 Schizoaffective disorder, manic type F25.1 Schizoaffective disorder, depressive type F25.2 Schizoaffective disorder, mixed type F25.8 Other schizoaffective disorders F25.9 Schizoaffective disorder, unspecifiedA fifth character may be used to classify the following subtypes: .x0 Concurrent affective and schizophrenic symptoms only.x1 Concurrent affective and schizophrenic symptoms, plus persistence of the schizophrenic symptoms beyond the duration of the affective symptomsF28 Other nonorganic psychotic disordersF29 Unspecified nonorganic psychosis
F30-F39Mood [affective] disordersF30 Manic episode F30.0 Hypomania F30.1 Mania without psychotic symptoms F30.2 Mania with psychotic symptoms .20 With mood-congruent psychotic symptoms .21 With mood-incongruent psychotic symptoms F30.8 Other manic episodes F30.9 Manic episode, unspecifiedF31 Bipolar affective disorder F31.0 Bipolar affective disorder, current episode hypomanicF31.1 Bipolar affective disorder, current episode manic without psychotic symptomsF31.2 Bipolar affective disorder, current episode manic with psychotic symptoms .20 With mood-congruent psychotic symptoms .21 With mood-incongruent psychotic symptomsF31.3 Bipolar affective disorder, current episode mild or moderate depression .30 Without somatic syndrome .31 With somatic syndromeF31.4 Bipolar affective disorder, current episode severe depression without psychotic symptomsF31.5 Bipolar affective disorder, current episode severe depression with psychotic symptoms .50 With mood-congruent psychotic symptoms .51 With mood-incongruent psychotic symptoms F31.6 Bipolar affective disorder, current episode mixed F31.7 Bipolar affective disorder, currently in remission F31.8 Other bipolar affective disorders F31.9 Bipolar affective disorder, unspecifiedF32 Depressive episode F32.0 Mild depressive episode .00 Without somatic syndrome .01 With somatic syndrome
F32.1 Moderate depressive episode .10 Without somatic syndrome .11 With somatic syndrome F32.2 Severe depressive episode without psychotic symptoms F32.3 Severe depressive episode with psychotic symptoms .30 With mood-congruent psychotic symptoms .31 With mood-incongruent psychotic symptoms F32.8 Other depressive episodes F32.9 Depressive episode, unspecifiedF33 Recurrent depressive disorder F33.0 Recurrent depressive disorder, current episode mild .00 Without somatic syndrome .01 With somatic syndrome F33.1 Recurrent depressive disorder, current episode moderate .10 Without somatic syndrome .11 With somatic syndromeF33.2 Recurrent depressive disorder, current episode severe without psychotic symptomsF33.3 Recurrent depressive disorder, current episode severe with psychotic symptoms .30 With mood-congruent psychotic symptoms .31 With mood-incongruent psychotic symptoms F33.4 Recurrent depressive disorder, currently in remission F33.8 Other recurrent depressive disorders F33.9 Recurrent depressive disorder, unspecifiedF34 Persistent mood [affective] disorders F34.0 Cyclothymia F34.1 Dysthymia F34.8 Other persistent mood [affective] disorders F34.9 Persistent mood [affective] disorder, unspecifiedF38 Other mood [affective] disorders F38.0 Other single mood [affective] disorders .00 Mixed affective episode F38.1 Other recurrent mood [affective] disorders .10 Recurrent brief depressive disorder F38.8 Other specified mood [affective] disordersF39 Unspecified mood [affective] disorder
F40-F48Neurotic, stress-related and somatoform disordersF40 Phobic anxiety disorders F40.0 Agoraphobia .00 Without panic disorder .01 With panic disorder F40.1 Social phobias F40.2 Specific (isolated) phobias F40.8 Other phobic anxiety disorders F40.9 Phobic anxiety disorder, unspecifiedF41 Other anxiety disorders F41.0 Panic disorder [episodic paroxysmal anxiety] .00 Moderate .01 Severe F41.1 Generalized anxiety disorder F41.2 Mixed anxiety and depressive disorder F41.3 Other mixed anxiety disorders F41.8 Other specified anxiety disorders F41.9 Anxiety disorder, unspecifiedF42 Obsessive-compulsive disorder F42.0 Predominantly obsessional thoughts or ruminations F42.1 Predominantly compulsive acts [obsessional rituals] F42.2 Mixed obsessional thoughts and acts F42.8 Other obsessive-compulsive disorders F42.9 Obsessive-compulsive disorder, unspecifiedF43 Reaction to severe stress, and adjustment disorders F43.0 Acute stress reaction .00 Mild .01 Moderate .02 Severe F43.1 Post-traumatic stress disorder F43.2 Adjustment disorders .20 Brief depressive reaction .21 Prolonged depressive reaction .22 Mixed anxiety and depressive reaction .23 With predominant disturbance of other emotions .24 With predominant disturbance of conduct
.25 With mixed disturbance of emotions and conduct .28 With other specified predominant symptoms F43.8 Other reactions to severe stress F43.9 Reaction to severe stress, unspecifiedF44 Dissociative [conversion] disorders F44.0 Dissociative amnesia F44.1 Dissociative fugue F44.2 Dissociative stupor F44.3 Trance and possession disorders F44.4 Dissociate motor disorders F44.5 Dissociative convulsions F44.6 Dissociate anaesthesia and sensory loss F44.7 Mixed dissociative [conversion] disorders F44.8 Other dissociative [conversion] disorders .80 Gansers syndrome .81 Multiple personality disorder.82 Transient dissociative [conversion] disorders occurring in childhood and adolescence .88 Other specified dissociative [conversion] disorders F44.9 Dissociative [conversion] disorder, unspecifiedF45 Somatoform disorders F45.0 Somatization disorder F45.1 Undifferentiated somatoform disorder F45.2 Hypochondriacal disorders F45.3 Somatoform autonomic dysfunction .30 Heart and cardiovascular system .31 Upper gastrointestinal tract .32 Lower gastrointestinal tract .34 Genitourinary system .38 Other organ or system F45.4 Persistent somatoform pain disorder F45.8 Other somatoform disorders F45.9 Somatoform disorder, unspecifiedF48 Other neurotic disorders F48.0 Neurasthenia F48.1 Depersonalization-derealization syndrome F48.8 Other specified neurotic disorders F48.9 Neurotic disorder, unspecified
F50-F59Behavioural syndromes associated with physiologicaldisturbances and physical factorsF50 Eating disorders F50.0 Anorexia nervosa F50.1 Atypical anorexia nervosa F50.2 Bulimia nervosa F50.3 Atypical bulimia nervosa F50.4 Overeating associated with other psychological disturbances F50.5 Vomiting associated with other psychological disturbances F50.8 Other eating disorders F50.9 Eating disorder, unspecifiedF51 Nonorganic sleep disorders F51.0 Nonorganic insomnia F51.1 Nonorganic hypersomnia F51.2 Nonorganic disorder of the sleep-wake schedule F51.3 Sleepwalking [somnambulism] F51.4 Sleep terrors [night terrors] F51.5 Nightmares F51.8 Other nonorganic sleep disorders F51.9 Nonorganic sleep disorder, unspecifiedF52 Sexual dysfunction, not caused by organic disorder or disease F52.0 Lack or loss of sexual desire F52.1 Sexual aversion and lack of sexual enjoyment .10 Sexual aversion .11 Lack of sexual enjoyment F52.2 Failure of genital response F52.3 Orgasmic dysfunction F52.4 Premature ejaculation F52.5 Nonorganic vaginismus F52.6 Nonorganic dyspareunia F52.7 Excessive sexual driveF52.8 Other sexual dysfunction, not caused by organic disorder or diseaseF52.9 Unspecified sexual dysfunction, not caused by organic disorder or disease
F53 Mental and behavioural disorders associated with the puerperium, not elsewhere classifiedF53.0 Mild mental and behavioural disorders associated with the puerperium, not elsewhere classifiedF53.1 Severe mental and behavioural disorders associated with the puerperium, not elsewhere classifiedF53.8 Other mental and behavioural disorders associated with the puerperium, not elsewhere classified F53.9 Puerperal mental disorder, unspecifiedF54 Psychological and behavioural factors associated with disorders or diseases classified elsewhereF55 Abuse of non-dependence-producing substances F55.0 Antidepressants F55.1 Laxatives F55.2 Analgesics F55.3 Antacids F55.4 Vitamins F55.5 Steroids or hormones F55.6 Specific herbal or folk remedies F55.8 Other substances that do not produce dependence F55.9 UnspecifiedF59 Unspecified behavioural syndromes associated with physiological disturbances and physical factors
F60-F69Disorders of adult personality and behaviourF60 Specific personality disorders F60.0 Paranoid personality disorder F60.1 Schizoid personality disorder F60.2 Dissocial personality disorder F60.3 Emotionally unstable personality disorder .30 Impulsive type .31 Borderline type F60.4 Histrionic personality disorder F60.5 Anankastic personality disorder F60.6 Anxious [avoidant] personality disorder F60.8 Other specific personality disorders F60.9 Personality disorder, unspecifiedF61 Mixed and other personality disorders F61.0 Mixed personality disorder F61.1 Troublesome personality changesF62 Enduring personality changes, not attributable to brain damage and disease F62.0 Enduring personality change after catastrophic experience F62.1 Enduring personality change after psychiatric illness F62.8 Other enduring personality changes F62.9 Enduring personality change, unspecifiedF63 Habit and impulse disorders F63.0 Pathological gambling F63.1 Pathological fire-setting [pyromania] F63.2 Pathological stealing [kleptomania] F63.3 Trichotillomania F63.8 Other habit and impulse disorders F63.9 Habit and impulse disorder, unspecifiedF64 Gender identity disorders F64.0 Transsexualism F64.1 Dual-role transvestism F64.2 Gender identity disorder of childhood F64.8 Other gender identity disorders F64.9 Gender identity disorder, unspecified
F65 Disorders of sexual preference F65.0 Fetishism F65.1 Fetishistic transvestism F65.2 Exhibitionism F65.3 Voyeurism F65.4 Paedophilia F65.5 Sadomasochism F65.6 Multiple disorders of sexual preference F65.8 Other disorders of sexual preference F65.9 Disorder of sexual preference, unspecifiedF66 Psychological and behavioural disorders associated with sexual development and orientation F66.0 Sexual maturation disorder F66.1 Egodystonic sexual orientation F66.2 Sexual relationship disorder F66.8 Other psychosexual development disorders F66.9 Psychosexual development disorder, unspecifiedF68 Other disorders of adult personality and behaviour F68.0 Elaboration of physical symptoms for psychological reasonsF68.1 Intentional production or feigning of symptoms or disabilities, either physical or psychological [factitious disorder] F68.8 Other specified disorders of adult personality and behaviourF69 Unspecified disorder of adult personality and behaviour
F70-F79Mental retardationF70 Mild mental retardationF71 Moderate mental retardationF72 Severe mental retardationF73 Profound mental retardationF78 Other mental retardationF79 Unspecified mental retardationA fourth character may be used to specify the extent of associated impairment of behaviour: F7x.0 No, or minimal, impairment of behaviourF7x.1 Significant impairment of behaviour requiring attention or treatment F7x.2 Other impairments of behaviour F7x.3 Without mention of impairment of behaviour
F80-F89Disorders of psychological developmentF80 Specific developmental disorders of speech and language F80.0 Specific speech articulation disorder F80.1 Expressive language disorder F80.2 Receptive language disorder F80.3 Acquire aphasia with epilepsy [Landau-Kleffner syndrome] F80.8 Other developmental disorders of speech and language F80.9 Developmental disorder of speech and language, unspecifiedF81 Specific developmental disorders of scholastic skills F81.0 Specific reading disorder F81.1 Specific spelling disorder F81.2 Specific disorder of arithmetical skills F81.3 Mixed disorder of scholastic skills F81.8 Other developmental disorders of scholastic skills F81.9 Developmental disorder of scholastic skills, unspecifiedF82 Specific developmental disorder of motor functionF83 Mixed specific developmental disorderF84 Pervasive developmental disorders F84.0 Childhood autism F84.1 Atypical autism .10 Atypicality in age of onset .11 Atypicality in symptomatology .12 Atypicality in both age of onset and symptomatology F84.2 Retts syndrome F84.3 Other childhood disintegrative disorderF84.4 Overactive disorder associated with mental retardation and stereotyped movements F84.5 Aspergers syndrome F84.8 Other pervasive developmental disorders F84.9 Pervasive developmental disorder, unspecifiedF88 Other disorders of psychological developmentF89 Unspecified disorder of psychological development
F90-F98Behavioural and emotional disorders with onsetusually occurring in childhood and adolescenceF90 Hyperkinetic disorder F90.0 Disturbance of activity and attention F90.1 Hyperkinetic conduct disorder F90.8 Other hyperkinetic disorders F90.9 Hyperkinetic disorder, unspecifiedF91 Conduct disorders F91.0 Conduct disorder confined to the family context F91.1 Unsocialized conduct disorder F91.2 Socialized conduct disorder F91.3 Oppositional defiant disorder F91.8 Other conduct disorders F91.9 Conduct disorder, unspecifiedF92 Mixed disorders of conduct and emotions F92.0 Depressive conduct disorder F92.8 Other mixed disorders of conduct and emotions F92.9 Mixed disorder of conduct and emotions, unspecifiedF93 Emotional disorders with onset specific to childhood F93.0 Separation anxiety disorder of childhood F93.1 Phobic anxiety disorder of childhood F93.2 Social anxiety disorder of childhood F93.3 Sibling rivalry disorder F93.8 Other childhood emotional disorders F93.9 Childhood emotional disorder, unspecifiedF94 Disorders of social functioning with onset specific to childhood and adolescence F94.0 Elective mutism F94.1 Reactive attachment disorder of childhood F94.2 Disinhibited attachment disorder of childhood F94.8 Other childhood disorders of social functioning F94.9 Childhood disorder of social functioning, unspecified
F95 Tic disorders F95.0 Transient tic disorders F95.1 Chronic motor or vocal tic disorder F95.2 Combined motor and vocal tic disorder [de la Tourettes syndrome] F95.8 Other tic disorders F95.9 Tic disorder, unspecifiedF98 Other behavioural and emotional disorders with onset usually occurring in childhood and adolescence F98.0 Nonorganic enuresis .00 Nocturnal enuresis only .01 Diurnal enuresis only .02 Nocturnal and diurnal enureses F98.1 Nonorganic encopresis .10 Failure to acquire physiological bowel control.11 Adequate bowel control with normal faeces deposited in inappropriate places.12 Soiling that is associated with excessively fluid faeces such as with retention with overflow F98.2 Feeding disorder of infancy and childhood F98.3 Pica of infancy and childhood F98.4 Stereotyped movement disorders .40 Non-self-injurious .41 Self-injurious .42 Mixed F98.5 Stuttering [stammering] F98.6 ClutteringF98.8 Other specified behavioural and emotional disorders with onset usually occurring in childhood and adolescenceF98.9 Unspecified behavioural and emotional disorders with onset usually occurring in childhood and adolescence
F99Unspecified mental disorderF99 Mental disorder, not otherwise specified
F00 - F09 ORGANIC, INCLUDING SYMPTOMATIC, MENTAL DISORDERSDEMENTIAG1. Evidence of each of the following:(1) A decline in memory, which is most evident in the learning of new information, although in more severe cases, the recall of previously learned information may be also affected. The impairment applies to both verbal and non-verbal material. The decline should be objectively verified by obtaining a reliable history from an informant, supplemented, if possible, by neuropsychological tests or quantified cognitive assessments. The severity of the decline, with mild impairment as the threshold for diagnosis, should be assessed as follows:Mild: a degree of memory loss sufficient to interfere with everyday activities, though not so severe as to be incompatible with independent living (see comment on cultural aspects of "independent living" on page 24). The main function affected is the learning of new material. For example, the individual has difficulty in registering, storing and recalling elements in daily living, such as where belongings have been put, social arrangements, or information recently imparted by family members.Moderate: A degree of memory loss which represents a serious handicap to independent living. Only highly learned or very familiar material is retained. New information is retained only occasionally and very briefly. The individual is unable to recall basic information about where he lives, what he has recently been doing, or the names of familiar persons.Severe: a degree of memory loss characterized by the complete inability to retain new information. Only fragments of previously learned information remain. The subject fails to recognize even close relatives.(2) A decline in other cognitive abilities characterized by deterioration in judgement and thinking, such as planning and organizing, and in the general processing of information. Evidence for this should be obtained when possible from interviewing an informant, supplemented, if possible, by neuropsychological tests or quantified objective assessments. Deterioration from a previously higher level of performance should be established. The severity of the decline, with mild impairment as the threshold for diagnosis, should be assessed as follows:Mild. The decline in cognitive abilities causes impaired performance in daily living, but not to a degree making the individual dependent on others. More complicated daily tasks or recreational activities cannot be undertaken.Moderate. The decline in cognitive abilities makes the individual unable to function without the assistance of another in daily living, including shopping and handling money. Within the home, only simple chores are preserved.
Activities are increasingly restricted and poorly sustained.Severe. The decline is characterized by an absence, or virtual absence, of intelligible ideation. The overall severity of the dementia is best expressed as the level of decline in memory or other cognitiveabilities, whichever is the more severe (e.g. mild decline in memory and moderate decline in cognitive abilitiesindicate a dementia of moderate severity).G2. Preserved awarenenss of the environment (i.e. absence of clouding of consciousness (as defined in F05, criterion A)) during a period of time long enough to enable the unequivocal demonstration of G1. When there are superimposed episodes of delirium the diagnosis of dementia should be deferred.G3. A decline in emotional control or motivation, or a change in social behaviour, manifest as at least one of the following: (1) emotional lability; (2) irritability;(3) apathy;(4) coarsening of social behaviour.G4. For a confident clinical diagnosis, G1 should have been present for at least six months; if the period since the manifest onset is shorter, the diagnosis can only be tentative.Comments: The diagnosis is further supported by evidence of damage to other higher cortical functions, such asaphasia, agnosia, apraxia. Judgment about independent living or the development of dependence (upon others) need to take account ofthe cultural expectation and context. Dementia is specified here as having a minimum duration of six months to avoid confusion with reversiblestates with identical behavioural syndromes, such as traumatic subdural haemorrhage (S06.5), normal pressurehydrocephalus (G91.2) and diffuse or focal brain injury (S06.2 and S06.3). A fifth character may be used to indicate the presence of additional symptoms, in the categories F00-F03(F00 Dementia in Alzheimers disease; F01 Vascular dementia; F02 Dementia in diseases classified elsewhere; andF03 Unspecified dementia), as follows: .x0 without additional symptoms
.x1 with other symptoms, predominantly delusional .x2 with other symptoms, predominantly hallucinatory .x3 with other symptoms, predominantly depressive.x4 with other mixed symptoms A sixth character may be used to indicate the severity of the dementia: .xx0 mild .xx1 moderate .xx2 severe As mentioned above on page ?? the overall severity of the dementia depends on the level of memory orintellectual impairment, whichever is the more severe.F00 DEMENTIA IN ALZHEIMERS DISEASEA. The general criteria for dementia (G1 to G4) must be met.B. There is no evidence from the history, physical examination or special investigations for any other possible cause of dementia (e.g. cerebrovascular disease, Parkinsons disease, Huntingtons disease, normal pressure hydrocephalus), a sysytemic disorder (e.g. hypothyroidism, vit. B12 or folic acid deficiency, hypercalcaemia), or alcohol- or drug-abuse.Comments: The diagnosis is confirmed by post mortem evidence of neurofibrillary tangles and neuritic plaques inexcess of those found in normal ageing of the brain. The following features support the diagnosis, but are not necessary elements: Involvement of corticalfunctions as evidenced by aphasia, agnosia or apraxia; decrease of motivation and drive, leading to apathy and lack ofspontaneity; irritability and disinhibition of social behaviour; evidence from special investigations that there iscerebral atrophy, particularly if this can be shown to be increasing over time. In severe cases there may beParkinson-like extrapyramidal changes, logoclonia, and epileptic fits.Specification of features for possible subtypes. Because of the possibility that subtypes exist, it is recommended thatthe following characteristics be ascertained as a basis for a further classification: age at onset; rate of progression;the configuration of the clinical features, particularly the relative prominence (or lack) of temporal, parietal or frontallobe signs; any neuropathological or neurochemical abnormalities, and their pattern. The division of AD into subtypes can at present be accomplished in two ways: first by taking only the age ofonset and labeling AD as either early or late, with an approximate cut-off point at 65 years; or secondly, by assessinghow well the individual conforms to one of the two putative syndromes, early or late onset type.
It should be noted that it is unlikely that a sharp distinction exists between early and late onset type. Earlyonset type may occur in late life, just as late onset type may occasionally have an onset under the age of 65. Thefollowing criteria may be used to differentiate F00.0 from F00.1, but it should be remembered that the status of thissubdivision is still controversial.F00.0 Dementia in Alzheimers disease with early onset1. The criteria for dementia in Alzheimers disease (F00) must be met, and the age at onset being under 65 years.2. In addition, at least one of the following requirements must be met:(a) evidence of a relatively rapid onset and progression;(b) in addition to memory impairment, there is aphasia (amnesic or sensory), agraphia, alexia, acalculia, or apraxia (indicating the presence of temporal, parietal and/or frontal lobe involvement).F00.1 Dementia in Alzheimers disease with late onset1. The criteria for dementia in Alzheimers disease (F00) must be met and the age at onset must be 65 or more.2. In addition, at least one of the following requirements must be met:(a) evidence of a very slow, gradual onset and progression (the rate of the latter may be known only retrospectively after a course of 3 years or more);(b) predominance of memory impairment G1.1, over intellectual impairment G1.2 (see general criteria for dementia).F00.2 Dementia in Alzheimers disease, atypical or mixed type Use this term and code for dementias that have important atypical features or that fulfil criteria for both earlyand late onset type of Alzheimers disease. Mixed Alzheimers and vascular dementia is also included here.F00.9 Dementia in Alzheimers disease, unspecifiedF01 VASCULAR DEMENTIAG1. The general criteria for dementia (G1 to G4) must be met.
G2. Unequal distribution of deficits in higher cognitive functions, with some affected and others relatively spared. Thus memory may be quite markedly affected while thinking, reasoning and information processing may show only mild decline.G3. There is clinical evidence of focal brain damage, manifest as at least one of the following:(1) unilateral spastic weakness of the limbs; (2) unilaterally increased tendon reflexes;(3) an extensor plantar response;(4) pseudobulbar palsy.G4. There is evidence from the history, examination, or tests, of a significant cerebrovascular disease, which may reasonably be judged to be etiologically related to the dementia (e.g. a history of stroke; evidence of cerebral infarction). The following criteria may be used to differentiate subtypes of vascular dementia, but it should beremembered that the usefulness of this subdivision may not be generally accepted.F01.0 Vascular dementia of acute onsetA. The general criteria for vascular dementia (F01) must be met.B. The dementia develops rapidly (i.e. usually within one month, but within no longer than three months) after a succession of strokes, or (rarely) after a single large infarction.F01.1 Multi-infarct dementiaA. The general criteria for vascular dementia (F01) must be met.B. The onset of the dementia is gradual (i.e. within three to six months), following a number of minor ischaemic episodes.Comments: It is presumed that there is an accumulation of infarcts in the cerebral parenchym. Between theischaemic episodes there may be periods of actual clinical improvement.F01.2 Subcortical vascular dementiaA. The general criteria for vascular dementia (F01) must be met.
B. A history of hypertension.C. Evidence from clinical examination and special investigations of vascular disease located in the deep white matter of the cerebral hemispheres, with preservation of the cerebral cortex.F01.3 Mixed cortical and subcortical vascular dementia Mixed cortical and subcortical components of the vascular dementia may be suspected from the clinicalfeatures, the results of investigations (including autopsy), or both.F01.8 Other vascular dementiaF01.9 Vascular dementia, unspecifiedF02 DEMENTIA IN OTHER DISEASES CLASSIFIED ELSEWHEREF02.0 Dementia in Picks diseaseA. The general criteria for dementia (G1 to G4) must be met.B. Slow onset with steady deterioration.C. Predominance of frontal lobe involvement evidenced by two or more of the following:(1) emotional blunting;(2) coarsening of social behaviour;(3) disinhibition; (4) apathy or restlessness;(5) aphasia.D. Relative preservation, in the early stages, of memory and parietal lobe functions.F02.1 Dementia in Creutzfeldt-Jakob diseaseA. The general criteria for dementia (G1 to G4) must be met.
B. Very rapid progression of the dementia, with disintegration of virtually all higher cerebral functions.C. The emergence, usually after or simultaneously with the dementia, of one or more of the following types of neurological symptoms and signs: (1) pyramidal symptoms; (2) extrapyramidal symptoms;(3) cerebellar symptoms; (4) aphasia;(5) visual impairment.Comments: An akinetic and mute state is the typical terminal stage. An amyotrophic variant may be seen,where the neurological signs precede the onset of the dementia. A characteristic electroencephalogram (periodicspikes against a slow and low voltage background), if present in association with the above clinical signs, willincrease the probability of the diagnosis. However, the diagnosis can be confirmed only by neuropathologicalexamination (neuronal loss, astrocytosis, and spongiform changes). Because of the risk of infection, this should becarried out only under special protective conditions.F02.2 Dementia in Huntingtons diseaseA. The general criteria for dementia (G1 to G4) must be met.B. Subcortical functions are affected first and dominate the picture of dementia throughout; manifest as slowness of thinking or movement and personality alteration with apathy or depression.C. Presence of involuntary choreiform movements, typically of the face, hands or shoulders, or in the gait. The patient may attempt to conceal them by converting them into a voluntary action.D. A history of Huntingtons disease in one parent or a sibling; or a family history which suggests the disorder.E. The absence of clinical features otherwise accounting for the abnormal movements.Comments: In addition to involuntary choreiform movements there may be development of extrapyramidal rigidity,or spasticity with pyramidal signs.F02.3 Dementia in Parkinsons disease
A. The general criteria for dementia (G1 to G4) must be met.B. Diagnosis of Parkinsons disease.C. Absence of cognitive impairment attributable to anti-parkinsonian medication.D. There is no evidence from the history, physical examination or special investigations for any other possible cause of dementia, including other forms of brain disease, damage or dysfunction (e.g. cerebrovascular disease, HIV disease, Huntingtons disease, normal pressure hydrocephalis), a systemic disorder (e.g. hypothyroidism, vit. B12 or folic acid deficiency, hypercalcaemia), or alcohol or drug abuse. If criteria are also fulfilled for dementia in Alzheimers disease with late onset (F00.1), this category F00.1should be used in combination with Parkinsons disease G20.F02.4 Dementia in human immunodeficiency (HIV) diseaseA. The general criteria for dementia (G1 to G4) must be met.B. Diagnosis of HIV infection.C. There is no evidence from the history, physical examination or special investigations for any other possible cause of dementia, including other forms of brain disease, damage or dysfunction (e.g. Alzheimers disease, cerebrovascular disease, Parkinsons disease, Huntingtons disease, normal pressure hydrocephalis), a systemic disorder (e.g. hypothyroidism, vit. B12 or folic acid deficiency, hypercalcaemia), or alcohol or drug abuse.F02.8 Dementia in other specified diseases classified elsewhere Dementia can occur as a manifestation or consequence of a variety of cerebral and somatic conditions. Tospecify the etiology, the ICD-10 code for the underlying condition should be added.F03 UNSPECIFIED DEMENTIA This category should be used when the general criteria for dementia are met, but when it is not possible toidentify one of the specific types (F00.0-F02.9).FO4 ORGANIC AMNESIC SYNDROME, NOT INDUCED BY ALCOHOL AND OTHER PSYCHOACTIVE SUBSTANCES
A. Memory impairment, manifest in both:(1) a defect of recent memory (impaired learning of new material), to a degree sufficient to interfere with daily living; and(2) a reduced ability to recall past experiences.B. Absence of:(1) a defect in immediate recall (as tested, for example, by the digit span);(2) clouding of consciousness and disturbance of attention, as defined in FO5, criterion A;(3) global intellectual decline (dementia).C. Objective evidence (physical & neurological examination, laboratory tests) and/or history of an insult to or a disease of the brain (especially involving bilaterally the diencephalic and medial temporal structures but other than alcoholic encephalopathy) that can reasonably be presumed to be responsible for the clinical manifestations described under A.Comments: Associated features, including confabulations, emotional changes (apathy, lack of initiative), and lack ofinsight, are useful additional pointers to the diagnosis but are not invariably present.FO5 DELIRIUM, NOT INDUCED BY ALCOHOL AND OTHER PSYCHOACTIVE SUBSTANCESA. Clouding of consciousness, i.e. reduced clarity of awareness of the environment, with reduced ability to focus, sustain, or shift attention.B. Disturbance of cognition, manifest by both:(1) impairment of immediate recall and recent memory, with relatively intact remote memory;(2) disorientation in time, place or person.C. At least one of the following psychomotor disturbances:(1) rapid, unpredictable shifts from hypo-activity to hyper-activity; (2) increased reaction time;
(3) increased or decreased flow of speech; (4) enhanced startle reaction.D. Disturbance of sleep or the sleep-wake cycle, manifest by at least one of the following:(1) insomnia, which in severe cases may involve total sleep loss, with or without daytime drowsiness, or reversal of the sleep-wake cycle;(2) nocturnal worsening of symptoms;(3) disturbing dreams and nightmares which may continue as hallucinations or illusions after awakening.E. Rapid onset and fluctuations of the symptoms over the course of the day.F. Objective evidence from history, physical and neurological examination or laboratory tests of an underlying cerebral or systemic disease (other than psychoactive substance-related) that can be presumed to be responsible for the clinical manifestations in A-D.Comments: Emotional disturbances such as depression, anxiety or fear, irritability, euphoria, apathy or wonderingperplexity, disturbances of perception (illusions or hallucinations, often visual) and transient delusions are typical butare not specific indications for the diagnosis. Use the fourth character to indicate whether the delirium is superimposed on dementia or not:F05.0 Delirium, not superimposed on dementiaF05.1 Delirium, superimposed on dementiaF05.8 Other deliriumF05.9 Delirium, unspecifiedFO6 OTHER MENTAL DISORDERS DUE TO BRAIN DAMAGE AND DYSFUNCTION AND TO PHYSICAL DISEASEG1. Objective evidence (from physical and neurological examination and laboratory tests) and/or history of cerebral disease, damage or dysfunction, or of systemic physical disorder known to cause cerebral dysfunction, including hormonal disturbances (other than alcohol or other psychoactive substance-related)
and non-psychoactive drug effects.G2. A presumed relationship between the development (or marked exacerbation) of the underlying disease, damage or dysfunction, and the mental disorder, the symptoms of which may have immediate onset or may be delayed.G3. Recovery or significant improvement of the mental disorder following removal or improvement of the underlying presumed cause.G4. Absence of sufficient or suggestive evidence for an alternative causation of the mental disorder, e.g. a highly loaded family history for a clinically similar or related disorder. If criteria G1, G2, and G4 are met, a provisional diagnosis is justified; if, in addition, there is evidence ofG3, the diagnosis can be regarded as certain.FO6.0 Organic hallucinosisA. The general criteria for F06 must be met.B. The clinical picture is dominated by persistent or recurrent hallucinations (usually visual or auditory).C. Occurrence of hallucinations in clear consciousness.Comments: Delusional elaboration of the hallucinations, as well as full or partial insight, may or may not be present:these features are not essential for the diagnosis.FO6.1 Organic catatonic disorderA. The general criteria for F06 must be met.B. One of the following must be present:(1) Stupor i.e. profound diminution or absence of voluntary movements and speech, and of normal responsiveness to light, noise and touch, but in the presence of maintenance of normal muscle tone, static posture and breathing (with often limited coordinated eye movements).(2) Negativism (positive resistance to passive movement of limbs or body or rigid posturing).C. Catatonic excitement (gross hypermotility of a chaotic quality with or without a tendency to assaultiveness).
D. Rapid and unpredictable alternation of stupor and excitement.Comments: The confidence in the diagnosis will be increased if additional catatonic phenomena are present, e.g.stereotypies, waxy flexibility, and impulsive acts. Care should be taken to exclude delirium; however, it is not knownat present whether an organic catatonic state always occurs in clear consciousness, or it represents an atypicalmanifestation of a delirium in which criteria A, B and D are only marginally met while criterion C is prominent.F06.2 Organic delusional [schizophrenia-like] disorderA. The general criteria for F06 must be met.B. The clinical picture is dominated by delusions (of persecution, bodily change, disease, death, jealousy) which may exhibit varying degree of systematization.C. Consciousness is clear and memory is intact.Comments: Further features which complete the clinical picture but are not invariably present include: hallucinations(in any modality); schizophrenic-type thought disorder; isolated catatonic phenomena such as stereotypies,negativism, or impulsive acts. The clinical picture may meet the symptomatic criteria for schizophrenia (F20.0 - F20.3), persistentdelusional disorder (F22), or acute and transient psychotic disorders (F23). However, if the state also meets thegeneral criteria for a presumptive organic aetiology laid down in the introduction to F06, it should be classified here.It should be noted that marginal or non-specific findings such as enlarged cerebral ventricles or "soft" neurologicalsigns do not qualify as evidence for criterion G1 in the introduction.FO6.3 Organic mood [affective] disorderA. The general criteria for F06 must be met.B. The condition must meet the criteria for one of the affective disorders, laid down in F30-F32. The diagnosis of the affective disorder may be specified by using a fifth character: F06.30 Organic manic disorder F06.31 Organic bipolar disorder F06.32 Organic depressive disorder F06.33 Organic mixed affective disorderFO6.4 Organic anxiety disorder
A. The general criteria for F06 must be met.B. The condition must meet the criteria for either F41.0 or F41.1.F06.5 Organic dissociative disorderA. The general criteria for F06 must be met.B. The condition must meet the criteria for one of the subcategories F44.0-F44.8.FO6.6 Organic emotionally labile [asthenic] disorderA. The general criteria for F06 must be met.B. The clinical picture is dominated by emotional lability (uncontrolled, unstable, and fluctuating expression of emotions).C. There is a variety of unpleasant physical sensations such as dizziness or pains and aches.Comments: Fatiguability and listlessness (asthenia) are often present but are not essential for the diagnosis.F06.7 Mild cognitive disorderNote: The status of this construct is being examined. Specific research criteria must be viewed as tentative. A mainreason for its inclusion is to obtain further evidence allowing its differentiation from disorders such as dementia(F00), delirium (F05), amnesic disorders (F04) and several disorders in F07.A. The general criteria for F06 must be met.B. The presence of a disorder in cognitive function for most of the time for at least two weeks, as reported by the individual or a reliable informant. The disorder is exemplified by difficulties in any of the following areas: (1) New learning(2) Memory (e.g. recall)(3) Concentration(4) Thinking (e.g. slowing)
(5) Language (e.g. comprehension, word finding, etc.)C. Abnormality or decline in performance on neuropsychological tests (or quantified cognitive assessments).D. None of B (1)-(5) are such that a diagnosis can be made of dementia (F00-F03), amnesic disorders (F04), delirium (F05), postencephalitic syndrome (F07.1), postconcussional syndrome (F07.2), or other persisting cognitive impairment due to psychoactive substance use (F1x.74).Comments: If general criterion G1 is met because of the presence of CNS dysfunction, it is usually presumed that thisis the cause of the mild cognitive disorder. If criterion G1 is met because of the presence of a systemic physicaldisorder, it is often unjustified to assume that there is a direct causative relationship. Nevertheless, it may be useful insuch instances to record the presence of the systemic physical disorder as "associated" without implying a necessarycausation. An additional 5th character may be used for this: F06.70 not associated with a systemic physical disorderF06.71 associated with a systemic physical disorder.The systemic physical disorder should be recorded separately by its proper ICD-10 code.F06.8 Other specified mental disorders due to brain damage and dysfunction and to physical disease Examples are transient or mild abnormal mood states not meeting the criteria for organic mood disorder(F06.3), occurring during treatment with steroids or antidepressants.F06.9 Unspecified mental disorder due to brain damage and dysfunction and to physical diseaseFO7 PERSONALITY AND BEHAVIOURAL DISORDERS DUE TO BRAIN DISEASE, DAMAGE AND DYSFUNCTIONG1. Objective evidence (from physical and neurological examination and laboratory tests) and/or history, of cerebral disease, damage, or dysfunction.G2. Absence of clouding of consciousness and of significant memory deficit.G3. Absence of sufficient or suggestive evidence for an alternative causation of the personality or behaviour disorder that would justify its placement in section F6.
FO7.0 Organic personality disorderA. The general criteria for F07 must be met.B. At least three of the following features must be present over a period of six or more months:(1) Consistently reduced ability to persevere with goal-directed activities, especially ones involving longer periods of time and postponed gratification.(2) One or more of the following emotional changes: (a) emotional lability (uncontrolled, unstable, and fluctuating expression of emotions); (b) euphoria and shallow, inappropriate jocularity, unwarranted by the circumstances; (c) irritability and/or outbursts of anger and aggression; (d) apathy.(3) Disinhibited expression of needs or impulses without consideration of consequences or of social conventions (the subject may engage in antisocial acts such as stealing, inappropriate sexual advances, ravenous eating, or exhibit extreme disregard for personal hygiene).(4) Cognitive disturbances, typically in the form of: (a) excessive suspiciousness and paranoid ideas; (b) excessive preoccupation with a single theme such as religion, or rigid categorization of other peoples behaviour in terms of "right" and "wrong".(5) Marked alteration of the rate and flow of language production, with features such as circumstantiality, over-inclusiveness, viscosity, and hypergraphia.(6) Altered sexual behaviour (hyposexuality or change in sexual preference).Specification of features for possible subtypesOption 1: A marked predominance of (1) and (2d) is thought to define a pseudoretarded or apathetic type; apredominance of (1), (2c) and (3) a pseudopsychopathic type; and the combination of (4), (5) and (6) is regarded ascharacteristic of the limbic epilepsy personality syndrome. None of these entities has yet been sufficiently validatedto warrant a separate description.Option 2: If desired, the following types may be specified: labile type, disinhibited type, aggressive type, apathetictype, paranoid type, mixed or other.FO7.1 Postencephalitic syndromeA. The general criteria for F07 must be met.
B. Residual neurological signs; manifest in at least one of the following:(1) paralysis;(2) deafness; (3) aphasia; (4) constructional apraxia; (5) acalculia.C. The syndrome is reversible, and its duration rarely exceeds 24 months.Comments: Criterion C constitutes the main differentiating feature from organic personality disorder (FO7.0). Residual symptoms and behavioural change following either viral or bacterial encephalitis arenon-specific and do not provide a sufficient basis for a clinical diagnosis. They may include: general malaise,apathy or irritability; some lowering of cognitive functioning (learning difficulties); disturbances in the sleep-wakepattern; or altered sexual behaviour.FO7.2 Postconcussional syndromeNote: The nosological status of this syndrome is uncertain, and criterion A of the introduction to this rubric is notalways ascertainable. However, for those undertaking research into this condition, the following criteria arerecommended:A. The general criteria of F07 must be met.B. History of head trauma with loss of consciousness, preceding the onset of symptoms by a period of up to four weeks (objective EEG, brain imaging, or oculonystagmographic evidence for brain damage may be lacking).C. At least three of the following:(1) Complaints of unpleasant sensations and pains, such as headache, dizziness (usually lacking the features of true vertigo), general malaise and excessive fatigue. or noise intolerance.(2) Emotional changes, such as irritability, emotional lability, both easily provoked or exacerbated by emotional excitement or stress, or some degree of depression and/or anxiety.(3) Subjective complaints of difficulty in concentration and in performing mental tasks, and
of memory complaints, without clear objective evidence (e.g. psychological tests) of marked impairment.(4) Insomnia.(5) Reduced tolerance to alcohol.(6) Preoccupation with the above symptoms and fear of permanent brain damage, to the extent of hypochondriacal over-valued ideas and adoption of a sick role.F07.8 Other organic personality and behavioural disorders due to brain disease, damage and dysfunction Brain disease, damage, or dysfunction may produce a variety of cognitive, emotional, personality, andbehavioural disorders, some of which may not be classifiable under the preceding rubric. However, since thenosological status of the tentative syndromes in this area is uncertain, they should be coded as "other". A fifthcharacter may be added, if necessary, to identify presumptive individual entities.F07.9 Unspecified organic personality and behavioural disorder, due to brain disease, damage and dysfunctionF09 UNSPECIFIED ORGANIC OR SYMPTOMATIC MENTAL DISORDER
F10 - F19 MENTAL AND BEHAVIOURAL DISORDERS DUE TO PSYCHOACTIVE SUBSTANCE USEF10.- DISORDERS DUE TO USE OF ALCOHOLF11.- DISORDERS DUE TO USE OF OPIOIDSF12.- DISORDERS DUE TO USE OF CANNABINOIDSF13.- DISORDERS DUE TO USE OF SEDATIVES OR HYPNOTICSF14.- DISORDERS DUE TO USE OF COCAINEF15.- DISORDERS DUE TO USE OF OTHER STIMULANTS, INCLUDING CAFFEINEF16.- DISORDERS DUE TO USE OF HALLUCINOGENSF17.- DISORDERS DUE TO USE OF TOBACCOF18.- DISORDERS DUE TO USE OF VOLATILE SOLVENTSF19.- DISORDERS DUE TO MULTIPLE DRUG USE AND USE OF OTHER PSYCHOACTIVE SUBSTANCESF1x.0 Acute intoxicationG1. Clear evidence of recent use of a psychoactive substance (or substances) at sufficiently high dose levels to be consistent with intoxication.G2. Symptoms or signs of intoxication compatible with the known actions of the particular substance (or substances), as specified below, and of sufficient severity to produce disturbances in the level of consciousness, cognition, perception, affect or behaviour which are of clinical importance.G3. Not accounted for by a medical disorder unrelated to substance use, and not better accounted for by another mental or behavioural disorder. Acute intoxication frequently occurs in persons who have more persistent alcohol- or drug-related problemsin addition. Where there are such problems, e.g. harmful use (F1x.1), dependence syndrome (F1x.2), or psychoticdisorder (F1x.5), they should also be recorded too. The following fifth character codes may be used to indicate whether the acute intoxication was associatedwith any complications:
F1x.00 UncomplicatedSymptoms of varying severity, usually dose-dependent.F1x.01 With trauma or other bodily injury.F1x.02 With other medical complications.Examples are haematemesis, inhalation of vomit.F1x.03 With delirium.F1x.04 With perceptual distortions.F1x.05 With coma.F1x.06 With convulsions.F1x.07 Pathological intoxication (applies only to alcohol).F10.0 Acute alcohol intoxicationA. The general criteria for acute intoxication (F1x.0) are met.B. Dysfunctional behaviour, as evidenced by at least one of the following:(1) disinhibition;(2) argumentativeness;(3) aggression;(4) lability of mood;(5) impaired attention;(6) impaired judgement;(7) interference with personal functioning.C. At least one of the following signs:(1) unsteady gait;(2) difficulty standing;(3) slurred speech;(4) nystagmus;(5) decreased level of consciousness (e.g. stupor, coma);(6) flushed face,(7) conjunctival injection.Comment: Acute alcohol intoxication when severe may be accompanied by hypotension, hypothermia, anddepression of the gag reflex. If desired, the blood alcohol level may be specified by using codes Y90.0 - Y90.8. Code Y91 may be usedto specify the clinical severity of intoxication, where the blood alcohol level is not available.